MDS Data to Be Used in Case Mix Calculations Posted for Review
The window for providers to review their Minimum Data Set (MDS) data is now open. Nursing homes have until Dec. 14th to review their MDS data posted on the Health Commerce System (HCS) and update the payer, special population flags (BMI, TBI, Dementia), and specialty unit information. When making updates, please ensure that the information reflects the situation at the time of the Assessment Reference Date (ARD) of the specific MDS. The posted data is from assessments with reference dates spanning April 1, 2023 and Sept. 30, 2023.
The data will be the basis for calculating the case mix index that will adjust January 2024 Medicaid rates for acuity. Due to updates made to the MDS form on Oct. 1, 2023, the State is shifting from a Resource Utilization Group (RUG)-based case mix methodology to one similar to the Patient-Driven Payment Model (PDPM) used to set Medicare Part A rates. The State intends to freeze the case mix until the new methodology is implemented, meaning that the January 2024 operating rate is likely to be in effect for a year or more. This makes a thorough review to ensure the accuracy of the posted MDS data especially important. While it is not yet clear what the contours of the State’s PDPM-like methodology for Medicaid will look like, we recommend that members continue to submit complete and accurate MDS assessments for Medicaid residents, cognizant that those items that are important for Medicare PDPM rate determination may also eventually be used to adjust Medicaid payments for acuity.
Some members report encountering duplicate assessments as they review the posted data. Although the Department of Health (DOH) updated the data recently, which reduced the number of duplicates, providers should let DOH know if they see duplicate Medicaid assessments (i.e., assessments for the same resident with the same ARD). The Department requests that providers notify them by submitting the name, date of birth, Social Security number, and ARD on the duplicate assessment. This resident-identifying information should be sent via the HCS's secure transfer application and addressed to “BLTCRMDS Group.” Instructions for using secure transfer are on page 24 of the slide set that DOH used in a 2021 webinar on the MDS review process (available here). Only duplicate Medicaid assessments need to be reported – other payer assessments are not considered.
Once the review is complete, providers should submit the signed and notarized MDS Certification by email to NFMDS@health.ny.gov. This should be done immediately, but no later than seven days after the review. All reviews should be completed no later than Dec. 14th, which means that all certifications must be in no later than Dec. 21st.
The associated Dear Administrator Letter (DAL) is available here; a copy of the Certification form is here.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841